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3	What is measured in an exercise test? VO2 VCO2 Ventilation Heart rate Heart rhythm Blood pressure
4	What is measured in an exercise test? Maximal VO2 (highest attainable) Anaerobic Threshold (highest sustainable) Breathing Efficiency etc….. VO2 VCO2 Ventilation Heart rate Heart rhythm Blood pressure
5	The oxygen cost of exercise Quiet rest 250 ml/min 1 MET Cycling 0 resistance 500 ml/min 2 MET Walking 2 - 3 mph 750 ml/min 3 MET Jogging 5 mph 1250 ml/min 5 MET Running 6-7 mph 2600 ml/min 10 MET
6	What determines VO₂? VO₂_max= Cardiac Output _max x O₂ Extraction _max
7	What is measured in an exercise test? Maximal VO2 (highest attainable) Anaerobic Threshold (highest sustainable) Breathing Efficiency etc….. VO2 VCO2 Ventilation Heart rate Heart rhythm Blood pressure
8	What’s so important about VO₂? Muscles and other body parts need oxygen It takes three times as much oxygen to walk around as it does to stand still Delivering oxygen is the circulation’s main job Measuring oxygen use (VO₂) tells us about the health of the circulation
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12	PPH Survival According to NYHA Functional Class (NIH Registry -1980’s data) NYHA Class Median Survival I and II 58.6 months III 31.5 months IV 6 months
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37	Why do we expect exercise to helpful? By improving the efficiency of your muscles to extract and utilize as much oxygen as possible The car analogy: fuel injectors, engine efficiency, and exhaust systems
38	What type of exercise is best? Safest? Aerobic exercise at lower intensities Typically at 50-75% of your maximum ability Higher intensities (65-75%) should be reserved for situations where you are monitored by a clinician Not a higher intensity than 75% (need to train more like a distance runner than a sprinter) No weightlifting/heavy resistance? More research needed. Concerns about valsalva maneuver increasing likelihood of syncope (passing out) No Matter what: Use your symptoms as your guide!
39	How do I exercise when I get short of breath just walking around my house? The key is energy conservation and controlled breathing techniques
40	Energy Conservation Spending oxygen is like a spending money on a credit card….. You need to be able to “pay as you go” Everyone can climb stairs…..it’s just a question of how fast and how much breathing is needed
41	Controlled Breathing In PH, gas exchange between your bloodstream and lungs is limited (both oxygen and carbon dioxide) The part you can control is how effectively you move air in and out of your lungs
42	More on controlled breathing Avoiding short, shallow breaths will maximize the clearance of carbon dioxide and the delivery of oxygen to as much of your lungs as possible Think about what happens when breathing through a snorkel…… Use your breathing as an indicator of what the best pace of activity is for you
43	Borg Dyspnea Scale 0 Nothing at all 0.5 very, very slight (just noticeable) 1 very slight 2 slight (light) 3 moderate 4 somewhat severe 5 severe (heavy) 6 7 very severe 8 9 10 very, very severe (almost max) Borg, G.A.V. Psychophysical bases of perceived exertion. Medicine and Science in Sports and Exercise 1982;14(5):377-381.
44	Putting it all together! By staying in control of your breathing, you will know what speed you can do with any activity. Exercise will be any continuous activity that you can do while maintaining an RPE of < 3
45	What might those activities be? They will vary from person to person! Arthritis/joint problems Home environment Neighborhood environment Equipment Infusion The key is individualization based on breathing and other factors
46	Some ideas…..
47	Keeping it safe! Physician clearance Initial instruction by a clinician to assess your response to physical activities at various intensities (EKG, BP, HR, oxygen saturation, etc No exercising when alone Please refer to the “Pointers on Exercise” section of your handout. http://www.phcentral.org/caphforum/resources/diet_exercise_print.html